{"id":"ef74e21cb07b","type":"article","url":"https://hartvaat.nl/2018/06/01/geindividualiseerd-patiromer-doseringsregime-bij-hf-met-ckd-en-hyperkaliemie/","title":"Geïndividualiseerd patiromer-doseringsregime bij HF met CKD en hyperkaliëmie","title_en":"Evaluation of an individualized dose titration regimen of patiromer to prevent hyperkalaemia in patients with heart failure and chronic kidney disease.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","ijzertekort","vrouwen"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12265","source_url":"https://doi.org/10.1002/ehf2.12265","authors":["Bertram Pitt","David A Bushinsky","Dalane W Kitzman","Frank Ruschitzka","Marco Metra","Gerasimos Filippatos","Patrick Rossignol","Charles Du Mond","Dahlia Garza","Lance Berman","Mitja Lainscak"],"significance":6,"published":"2018-06-01","source_date":"2018-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/lisdiuretica-furosemide-bumetanide/"],"congress":"","summary_en":"This study evaluated an individualized patiromer dosing regimen for preventing hyperkalemia in heart failure patients with CKD, demonstrating that tailored potassium management enables optimized RAAS inhibitor therapy.","created":"2026-07-03T10:27:18Z","updated":"2026-07-03T13:26:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar een geïndividualiseerd doseringsregime van patiromer ter preventie van hyperkaliëmie bij patiënten met hartfalen en chronische nierziekte.","abstract_original":"AIMS: Hyperkalaemia risk precludes optimal renin-angiotensin-aldosterone system inhibitor use in patients with heart failure (HF), particularly those with chronic kidney disease (CKD). Patiromer is a sodium-free, non-absorbed potassium (K+ )-binding polymer approved for the treatment of hyperkalaemia. In PEARL-HF, patiromer 25.2 g (fixed dose) prevented hyperkalaemia in HF patients with or without CKD initiating spironolactone. The current study evaluated the effectiveness of a lower starting dose of patiromer (16.4 g/day) followed by individualized titration in preventing hyperkalaemia and hypokalaemia when initiating spironolactone. METHODS AND RESULTS: This open-label 8-week study enrolled 63 patients with CKD, serum K+ 4.3-5.1 mEq/L, and chronic HF, who, based on investigator opinion, should receive spironolactone. Eligible patients started spironolactone 25 mg/day and patiromer 16.8 g/day (divided into two doses), with patiromer titrated to maintain serum K+ 4.0-5.1 mEq/L. Mean (standard deviation) serum K+ was 4.78 (0.51) mEq/L at baseline; weekly values were 4.48-4.70 mEq/L during treatment. Serum K+ of 3.5-5.5 mEq/L at the end of study treatment (primary endpoint) was achieved by 57 (90.5%) patients; 53 (84.1%) had serum K+ 4.0-5.1 mEq/L. One patient (1.6%) developed hypokalaemia, and two patients (3.2%) developed hypomagnesaemia. Spironolactone was increased to 50 mg/day in all patients; 43 (68%) patients required one or more patiromer dose titration. Adverse events (AEs) occurred in 36 (57.1%) patients, with a low rate of discontinuations [four (6.3%) patients]. The most common AE was mild to moderate abdominal discomfort [four (6.3%) patients]. CONCLUSIONS: In this open-label study, patiromer 16.8 g/day followed by individualized titration maintained serum K+ within the target range in the majority of patients with HF and CKD, all of whom were uptitrated to spironolactone 50 mg/day, patiromer was well tolerated, with a low incidence of hyperkalaemia, hypokalaemia, and hypomagnesaemia."}